Pamantasan ng Cabuyao

COLLEGE OF NURSING

STRENGTHENING HEALTH CARE SERVICES

IN THE CITY OF CABUYAO

CABAG JR., ELENO T.

CASTILLO, CLYDE ALECZANDRE P.

SALAZAR, ARVIN E.

CHAPTER 1

Introduction
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An efficient healthcare system delivers reasonable access to quality care

regardless of an individual’s capabilities to spend while guaranteeing them against the

monetary effects of poor health, according to World Health Organization (2014).

On the other hand, definition of World Health Organization (WHO) is evidently not

valid to the Philippine healthcare system. Health outcomes and access to health care

services in the Philippines are branded by a persistent difficulty for the poor. The

bottom of Philippine Healthcare system shortcomings are three major problems: lack of

manpower, administrative decentralization and health policy fragmentation. Health

centers providing services to most of the people, especially the poor, continued to be

short-staffed as health professionals, are being lured to health careers with better

perks and incentives elsewhere. In particular, primary healthcare level depends on

limited local government resources, yet has to absorb several disease-specific national

health programs (WHO, 2015).

Consistent with The National Demographic and Health Survey, report shows that

the most of patients admitted in both public and private hospitals do out-of-pocket

spending, using their salary or savings just have their needs for health. Out-of-pocket

payments were pointedly dominant among patients confined in government hospitals

( National Demographic and Health Survey, 2014)

Referring to PhilHealth’s inadequate service coverage resulting in high out-of-

pocket spending, the WHO review inferred that the Philippine health financing system
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is not able to give security from the financial effects of illness because PhilHealth is

unable to provide full insurance coverage. Filipinos who get sick can easily slide into

poverty (WHO, 2015).

Subsequently, the World Health Organization (WHO) records that over the last

decade an increasing number of Filipino health professionals seeking for work with

more competitive salary have gone to other countries, resulting lack of doctors, nurses,

dentists and other health professionals to tackle the health needs of Filipinos (WHO,

2015).

However, better health outcomes, more efficient healthcare delivery system, and

more proportional health care funding can only be reached by a system serving at its

peak. This can be accomplished through systematic, reasonable, and joint efforts for

health and coordination is the key that holds together the joint efforts for health.

Cooperation and coordination in categories of healthcare are imperative for all health

workers from the barangay health stations (BHS) to the policy makers. Health facilities

have to coordinate themselves to be able to mutually meet with the changing times,

arising health concerns and reoccurring health concerns. Thankfully, Department of

Health (DOH) has been on the frontline of all these efforts for health to acquire the

health system goals of better health outcomes, more efficient healthcare delivery

system and more proportional health care funding which focuses on underprivileged

and Fourmula One for Health as the main basis which DOH launched in the utilization

of health sector reforms (DOH, 2014).

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The health care system in the country is commonly extensive, but access to

healthcare services especially by the poor is hindered by the financial, geographical

and socio-cultural barriers. So, access, affordability and availability of healthcare

services to the population especially to the poor has been a belligerent issue. To

address these issues, reform in the country’s health care system have been

implemented in the past 30 years (DOH, 2014).

Tackling the primary health care, could greatly affect the problem, therefore could

arise better health outcomes, more responsive health system, and more equitable

health care financing. However, the country still has a long way to go in attaining a

sustainable, high-quality, and cost-efficient healthcare system that can be utilized by all

Filipinos. Stable funding in primary care services all over the country may begin to

address the problem of the country’s healthcare system.  Primary health care is a

vital health care made generally available to people and suitable to them, in an

affordable cost. Primary health care does not only cater disease, but delivers

preventive health measures, disease management, and encouraging self-care.

Funding for primary health care would promote its sensibility as a practice option for

health professionals and elevate it as a priority for local governments. Primary health

care systems may then hire healthcare providers from both public and private sectors,

to address the lack of health workers and professionals between the two. In a primary

level of care, each health consultation is seen by a primary care provider, who serves
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holistic and continuing health treatment and teaching; and refers to an established

network of hospitals or specialists as necessary.

Program and Projects of LGU:1.) Facilitate the Expansion of the National

Health Insurance Program (NHIP)

However, in Cabuyao the support the Attainment of Universal Coverage for

Social Health Insurance Social marketing strategies shall be conducted among the

LGUs to increase the enrolment of the indigent families to the Sponsored Program of

the NHIP. The LGUs (City of Cabuyao) shall also assist in the implementation of social

marketing strategies to increase the enrolment of the informal sector to the NHIP. B.

Ensure Local Government Premium Counterpart The municipal, city and provincial

LGUs shall ensure the allocation of budget from their IRA for the payment of their

premium counterpart in the enrolment of indigent families to the Sponsored Program of

PhilHealth. The LGU (City of Cabuyao) may pursue legislation to peg a portion of their

Internal Revenue Allotment (IRA) to enroll the indigents identified in the tool for

identification of the poor. C. Adoption of PhilHealth Approved Tool/s for Identifying

Indigent Families The LGUs shall adopt the PhilHealth approved tool for identifying

indigent families for enrolment into the Sponsored Program of PhilHealth to ensure that

the true poor families will be given financial risk protection from catastrophic illnesses

through social health insurance. D. Hasten PhilHealth Accreditation of Facilities The

municipal, city and provincial LGUs shall ensure that their facilities such as the RHUs

and hospitals shall meet the accreditation criteria of PhilHealth for them to qualify for
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the release of capitation and reimbursement from PhilHealth. E. Rational use of

PhilHealth Capitation

The study will aim for assessment and improvement of healthcare services

under Cabuyao Government. The assessment of the study would define the

problems about healthcare services rendered by the LGU. Thus, would determine

the problems related to study, for improvement of programs for the betterment of

health among Cabuyenos.

Statement of the Problem

This research attempts to strengthen the Health Care Delivery System in Different

Barangays in the City of Cabuyao. More specifically it seeks to find the answers to the

following questions:

1. What is the profile of the respondents in selected barangays in City of

Cabuyao according to:

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1.1 Age

1.2 Gender

1.3 Civil Status

1.4 Family Income Level

1.5 Educational Attainment

1.6Length of residency

1.7 Frequency of visit

2. What is strengthening of health care services based by local government unit of

the City of Cabuyao in terms of:

2.1 Health care access

2.2 Health care services

2.3 Health care facilities

2.4 Health care equipment

2.5 Health Care Personnel

3. What is the significant difference in strengthening healthcare services when

grouped according to profile of the respondents?

4. What action plan can be proposed to strengthen healthcare services rendered

by local government unit of Cabuyao?

Hypothesis
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H0 : There is no significant difference in strengthening healthcare services by

local government unit on the demographic profile and the three steps in the nursing

process based on Jean Watson’s theory.

Theoretical Framework

The study was based on the nursing theory of Nola J. Pender’s Health Promotion

Model. Dr. Nola J. Pender (2002) developed the health Promotion Model (HMP)

that was used universally for research, education, and practices.

The health promotion model focuses on helping people achieve higher level of

well-being. It encourages health professionals to provide positive resources to

help patients achieve specific changes. The goal of health promotion model is not

just about helping patients prevent illnesses through their behavior, but to look at

ways in which a person can pursue better health or ideal health.

The health promotion model (HPM) proposed by Nola J. Pender (1982); revised

1996) designed to be a “complementary counterpart to model of health

protection”. It defines health as a “positive dynamic state not merely the absence

of disease”. Health promotion was directed at increase in a client’s level of well-

being. Nola J Pender’s theory’s purpose is to aid nurses in helping patients

identify health risk factors as well as beneficial practices in order to help the

patients actively determine which behavior will result in achieving optimum health.
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In addition, Pender (1982), the health promotion Model makes four assumptions:

Individual strives to control their own behavior, individuals work to improve

themselves and their environment; health professionals, such as nurses and

doctors, comprised the interpersonal environment which influence individual

behavior; self-initiated change of individual and environmental characteristics are

essential to changing behavior.

Moreover, Pender discussed different barriers to health resources in terms of

facilities: serve the place where the services are given; serve as the offered

services for health and wellness, equipment; serve as tool for giving health and

wellness, personnel; serve as the one who give health promotion, and

transportation; serve as health care access and also depends on health care and

assess the resources in promoting health. On the other hand, health protection

detect it early or maintaining functioning within the constraint of illness.

According to Pender, personal factors are categorized as biological, psychological

and socio-cultural. These factors are predictive of a given behavior and shaped by

the nature of the target behavior being considered. Biological personal factors

include variables such as age gender body mass index pubertal status, aerobic

capacity, strength, agility, or balance. Psychological personal factors include

variables such as self-esteem, self-motivation, personal competence, perceived

health status, and definition of health. Socio-cultural personal factors include

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variables such as race ethnicity, acculturation, education and socioeconomic

status.

Furthermore, interpersonal factors are cognition-concerning behaviors, beliefs, or

attitudes of the others. Interpersonal influences include: norms, social support,

and modeling. Primary sources of interpersonal influences are families, peers,

and healthcare providers. Health-promoting behavior is the endpoint or action

outcome directed toward attaining a positive

Survey health outcome such as optimal well-
Proposed
1. Assess the profile of the respondents in Questionnaire
being, personal fulfillment, and productive living. Action Plan to
according to:
& strengthen
1.1 Age
health care
1.2 Gender
Data Collection services
1.3 Civil Status
rendered by
1.4 Family Income Level
local
1.5 Educational Attainment
government unit
1.6 Length of Residency
of Cabuyao.
1.7 Frequency of Visit

2. Determine strengthening of health care

services based by local government unit of the

City of Cabuyao in terms of:

2.1 Health Care Access

2.2 Heath Care Services

2.3 Health Care Facilities

Conceptual Framework
2.4 Health Care Equipment

2.5 Health Care Personnel

INPUT PROCESS OUTPUT
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FEEDBACK

FIGURE 1. Conceptual Paradigm

Figure 1 shows the schematic diagram of the conceptual framework of the study.

The conceptual framework follows the IPO: input, process, output.

The input data will include the respondents profile in terms of age, sex, civil

status, socioeconomic status, highest educational attainment, length of residency,

and frequency of visit to healthcare facility. Also, the respondents will be assessed
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on strengthening of healthcare services in terms of healthcare access, services,

facilities, equipment, and personnel, Lastly, is to the significant difference in

strengthening healthcare services when grouped according to profile of the

respondents.

In the process box, data gathering procedures will be done by distribution of self-

made questionnaires based on the Health Promotion Model, to include descriptive

correlational analysis using five-point likert scale. In this sampling technique, the

respondents of the study will be randomly selected for each barangays. City

Health Office’s and Barangay Health Centers’ clients will have equal chance to be

part of the study and statistical treatment of data will be presented and discussed.

The output box will include the researchers’ proposed action plan for

strengthening health care services in the City of Cabuyao.

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Significance of the Study

The researchers believed that the understanding of healthcare services

and strengthening the roots of it are one way to reform up a great extent.

Community Health Office. It will help them to innovate approach to health needs

and strengthen community healthcare services.

Respondents of Cabuyao. It will help the citizens of Cabuyao in maximizing the

utilization of healthcare provided by the government. Use the right to instill health

awareness among them endowed by the Philippine Constitution.

College of Nursing. The result of this research would render plans for better and

effective delivery of healthcare services that motivates student to be more

competent and efficient.

Nursing Students. This study will help them to determine the importance of

reforming and strengthening the healthcare services rendered by the government

and how valuable the calling they are in.

Future Researchers. That this may give inspiration and somehow initiation of the

student nurses and registered nurses to have a room for further improvement with

regards to client’s health needs and perhaps, to ignite reforms and changes in

client expectations, not just to the nursing profession, but to the healthcare

services and healthcare delivery system that health professionals take part.
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Objective of the Study

The primary purpose of this study is to find the progress action plan for

Strengthening Health Care Services of Cabuyao. The researchers want to

achieve the following objectives.

2. Assess the profile of the respondents in according to:

1.3 Age

1.4 Gender

1.3 Civil Status

1.4 Family Income Level

1.5 Educational Attainment

1.6 Length of residency

1.7 Frequency of Visit

2. Strengthening of health care services based by local government unit of

the City of Cabuyao in terms of:

2.1 Health Care Access

2.2 Health Care Services

2.4 Health Care Facilities

2.4 Health Care Equipment

2.5 Health Care Personnel

3. Analyze the significant difference in strengthening healthcare services

when grouped according to profile of the respondents.

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4. Identify the action plan can be proposed to strengthen healthcare

services rendered by local government unit of Cabuyao.

Scope and Limitation

The study will give emphasis on the Strengthening of Health Care

Services in Cabuyao. Furthermore, the study determines progress action plan

using the theory of Jean Watson Theory of Human Caring. The study is

limited only to the services offered by the primary healthcare facilities of

Cabuyao; from Barangay Health Centers, Rural Health Units, and City Health

Offices under by the Local Government Unit. Also the researchers include the

demographic profile of the respondents in terms of age, gender, civil status,

family income level, educational attainment, and length of residency.

Moreover, It is limited only to the services offered of barangays in area

CHO-1. The researchers involved the citizens of top 5 barangays with the

highest population in the City of Cabuyao CHO-1, These were barangays

Marinig, Niugan, Butong, Bigaa, and Gulod.

Definition of Terms

Acculturation.  It refers to a process of social, psychological, and cultural change

that stems from blending between cultures

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Aerobic Capacity. It refers to a measure of the ability of the heart and lungs to

get oxygen to the muscles

Affect. It refers to an expression of emotion or feelings displayed to others

through facial expressions, hand gestures, voice tone, and other emotional signs

such as laughter or tears.

Age. It refers to the length of time that a person has lived or a thing has existed.

Agility. It refers to an ability to move quickly and easily.

Assessment. It refers to the continuous process of apprehending and

identifying manifestations of the human energy field and environmental

energy field patterns that relate to current health events.

Asian Development Bank. It refers to an international development finance

institution dedicated to reducing poverty in Asia and the Pacific through loans,

grants, research and technical assistance to its member countries, as well as

investments in private companies.

Balance. It refers to an even distribution of weight enabling someone or

something to remain upright and steady.

Barangay Health Station. It refers to members of a community who are

chosen by community members or organizations to provide basic health and

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medical care to their community capable of providing preventive, promotional

and rehabilitation care to these communities. Other names for this type

of health care provider include village health worker, community health aide,

community health promoter, and lay health adviser.

Barangays. It refers to smallest administrative division in the Philippines and is

the native Filipino term for a village, district or ward. In metropolitan areas, the

term often refers to an inner city neighborhood, a suburb or a suburban

neighborhood.

Barriers. It refers to a circumstance or obstacle that keeps people or things apart

or prevents communication or progress

Beliefs. It refers to the state of mind in which a person thinks something to be the

case with or without there being empirical evidence to prove that something is the

case with factual certainty.

Biological. It refers to biology or living organisms

Biopsychosocial Complexity. It refers to anything concerned with the biological,

psychological, and social aspects in contrast to the strictly biomedical aspects of

disease.
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Body Mass Index. It refers to weight-to-height ratio, calculated by dividing one's

weight in kilograms by the square of one's height in meters and used as an

indicator of obesity and underweight

Cabuyenos. It refers to residents of Cabuyao, Laguna

Cognition. It refers to mental action or process of acquiring knowledge and

understanding through thought, experience, and the senses

Collaboration. It refers to purposeful relationship in which all parties

strategically choose to cooperate in order to achieve shared or overlapping

objectives.

Collections. It refers to process of pursing payments of debts owed by

individuals or businesses.

Community Health Office. It refers to a health institution promoting health,

preventing diseases, prolonging life and improving the quality of life

Decentralization. It refers to process of distributing or dispersing functions,

powers, people or things away from a central location or authority.

Delivery System. It refers to means or procedure for providing a product or

service to the public.

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Dentist. It refers to surgeon who specializes in dentistry, the diagnosis,

prevention, and treatment of diseases and conditions of the oral cavity. 

Department of Health.  It refers to the executive department of the Philippine

government responsible for ensuring access to basic public health services by all

Filipinos through the provision of quality health care and the regulation of all

health services and products. 

Disease Management. It refers to a system that seeks to manage the chronic

conditions of high-risk, high-cost patients as a group.

Doctor. It refers to a professional who practices medicine, which is concerned

with promoting, maintaining, or restoring health through the study, diagnosis, and

treatment of disease, injury, and other physical and mental impairments.

Dynamic. It refers to process or system characterized by constant change,

activity, or progress.

Education. It refers to process of facilitating learning, or the acquisition of

knowledge, skills, values, beliefs, and habits.

Educational Attainment. It refers to the highest degree of education an

individual has completed.

Enactment. It refers to process of passing legislation

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Epidemic. It refers to a disease that spreads over a large area and affects

many people at the same time. Epidemics are when a disease spreads from

person to person faster than doctors can control.

Equitable. It refers to legal right guaranteed by equity as opposed to a legal

right which derives authority from a legal source.

Fourmula One. It refers to the strategy for implementing health reforms that has

been put into action by the different offices, bureaus, programs, and projects

including attached agencies since 2005.

Gender. It refers to the state of being male or female.

Health. It refers to state of complete physical, mental, and social well-being

and not merely the absence of disease or infirmity.

Health Care. It refers to the maintenance or improvement of health via the

prevention, diagnosis, and treatment of disease, illness, injury, and other physical

and mental impairments in human beings.

Health Care Access. It refers to a health care system that provides health

care and financial protection to all citizens of a particular country.

Health Care Equipment. It refers to anything used for the specific purposes of

diagnosis and treatment of disease or rehabilitation following disease or injury; it

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can be used either alone or in combination with any accessory, consumable or

other piece of medical equipment.

Health Care Facilities. It refers to places that provide health care. That include

hospitals, clinics, outpatient care centers, and specialized care centers, such as

birthing centers and psychiatric care centers.

Health Maintenance Organizations (HMOs). It refers to medical insurance

group that provides health services for a fixed annual fee.

Health Prioritization. It refers to the activity that arranges items or activities

in order of importance relative to each other.

Health Care Services. It refers to furnishing of medicine, medical or surgical

treatment, nursing, hospital service, dental service, optometrical service,

complementary health services or any or all of the enumerated services or any

other necessary services of like character, whether or not contingent upon

sickness or personal injury, as well as the furnishing to any person of any and all

other services and goods for the purpose of preventing, alleviating, curing or

healing human illness, physical disability or injury.

Health Needs. It refers to objectively determined deficiencies in health that

require health care, from promotion to palliation.

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Health Professionals. It refers to individual who provides preventive, curative,

promotional or rehabilitative health care services in a systematic way to people,

families or communities.

Health Promotion. It refers to process of enabling people to increase control

over, and to improve, their health. It moves beyond a focus on individual behavior

towards a wide range of social and environmental interventions.

Health Promotion Model. It refers to a theory to be a complementary

counterpart to models of health protection. It defines health as a positive dynamic

state rather than simply the absence of disease. Health promotion is directed at

increasing a patient's level of well-being.

Healthcare System. It refers to the organization of people, institutions, and

resources that deliver health care services to meet the health needs of target

populations.

Health-Promoting Behaviors. It refers to positive approach to living and a

means of increasing well-being and self-actualization

Incentive. It refers to something that motivates an individual to perform an action

Internal Revenue Allotment. It refers to local government unit's (LGU) share

of revenues from the Philippine national government.

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Interpersonal. It refers to relationships or communication between people.

Local Government Unit (LGU). It refers to institutional units whose fiscal,

legislative and executive authority extends over the smallest geographical

areas distinguished for administrative and political purposes. 

Local Health Account. It refers to major field of study within the medical and

clinical sciences which focuses on the maintenance, protection and

improvement of the health status of population groups and communities as

opposed to the health of individual patients. It is a distinct field of study that

may be taught within a separate school of public health or environmental

health.

Local Health Boards. It refers to the is an administrative unit within

the National Health Service.

Logical Analysis. It refers to an instrument of interpretation to shift the

interpretive focus from the purely exegetical approach towards a given text to

the systematic reconstruction of a theory that concerns the issues that are

discussed.

Modeling. It refers to vicarious learning through observing others engaged in a

particular behavior

Norms. It refers to expectations of significant others.

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Nurse. It refers to a person who is trained to give care to people who are sick or

injured. Nurses work with doctors and other health care workers to make patients

well and to keep them fit and healthy.

Nursing Students. It refers to a student in a post-secondary educational program

that leads to certification and licensing to practice nursing. 

Outcome. It refers to changes in health that result from measures or

specific health care investments or interventions.

Out-Of-Pocket Spending. It refers to direct payments made by individuals

to healthcare providers at the time of service use

Philippine Health Insurance Corporation (PhilHealth). It refers to a tax-

exempt, government-owned and government-controlled corporation (GOCC)

of the Philippines and is attached to the Department of Health.

Preventive Health Measures. It refers to measures taken for disease prevention,

as opposed to disease treatment.

Primary Health Care. It refers to health care at a basic rather than specialized

level for people making an initial approach to a doctor or nurse for treatment.

Psychological. It refers to  mental and emotional state of a person

Pubertal Status. It refers to a state of puberty of an individual.

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Quality of Life. It refers to the standard of health, comfort, and happiness

experienced by an individual or group.

Race Ethnicity. It refers to a person's physical characteristics, such as bone

structure and skin, hair, or eye color.

Reconfiguration. It refers to arrangement of parts or elements in a different form,

figure, or combination

Respondent. It refers to a person who replies to something, especially one

supplying information for a survey or questionnaire.

Self-Care. It refers to any necessary human regulatory function which is under

individual control, deliberate and self-initiated.

Self-Efficacy. It refers to one's belief in one's ability to succeed in specific

situations or accomplish a task

Self-Esteem. It refers to confidence in one's own worth or abilities;

Self-Motivation. It refers to ability to do what needs to be done, without influence

from other people or situations.

Social Health Insurance. It refers to form of financing and managing health

care based on risk pooling.

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Social Mobilization. It refers to mobilization of civilian population as part

of contentious politics.

Social Support. It refers to instrumental and emotional encouragement

Socio-Cultural. It refers to set of beliefs, customs, practices and behavior that

exists within a population

Socioeconomic Status. It refers to economic and sociological combined total

measure of a person's work experience and of an individual's or

family's economic and social position in relation to others, based on income,

education, and occupation.

Theory. It refers to a group of linked ideas intended to explain something. A

theory provides a framework for explaining observations. The explanations

are based on assumptions. From the assumptions follows a number of

possible hypotheses. They can be tested to provide support or challenge.

Therapeutic. It refers to the responses after a treatment of any kind, the

results of which are judged to be desirable and beneficial. This is true whether

the result was expected, unexpected, or even an unintended consequence of

the treatment.
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The National Demographic and Health Survey. It refers to nationally-

representative household surveys that provide data for a wide range of monitoring

and impact evaluation indicators in the areas of population, health, and nutrition.

Variables. symbolic name associated with a value and whose associated value

may be changed.

World Health Organization. a specialized agency of the United Nations that is

concerned with international public health. It was established on 7 April 1948

headquartered in Geneva, Switzerland.

CHAPTER 2

Review of Related Literature and Studies

Philippine Health Care System continues to evolve in scope of services, as

well as complexity of organizations and interrelationships between services and

providers; necessitating a shift in the policy making process away from political

influence and power of providers, toward evidence based on objective

performance measures.(DOH,2015).

Health Care
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Primary Health Care is a multi-dimensional system that has a

responsibility to organize care for individual for continuum of care and

understand and work with our partners to improve the health of communities.

(Kringo’s,2013)

Primary health care is a philosophy for organizing and delivering a range

of coordinated and collaborative community-based services that empower

individuals, families and communities to take responsibility for their health and

well-being. Effective primary health care requires a culture and system designed

to be responsive to individual and population health needs (Government of

Newfoundland and Labrador, 2015,)

According to Allianz 2018 the healthcare system in the Philippines is a

mixed public-private system. Public health care is organized in 2 tiers: Primary

care is delivered through public health and primary health care centers linked to

peripheral barangay health centers (BHCs) or health outposts. Private healthcare

services are well-established and growing in Philippines through specialist clinics

and private hospitals. The private sector is much larger than the public sector in

terms of human, financial and technological resources and caters to 30% of the

population. It is structured according to the North American model organized

around independent free-standing hospitals, individual medical offices and

private clinics, dependent on fee-for-service payments(REFFERENCE)

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The Primary Health Care Delivery System of Medical Ambassador

Philippines includes Community Organization resulting in the formation by the

community of a duly elected Barangay Health Committee. Health Education and

training of Barangay Health Workers (BHW) is an important component of the

program under the supervision of the nurse assigned to a particular project site.

The objective of this program is to ensure that by the end of the first year, the

community has at least one functioning BHW or one BHW per 20 households. By

the end of the second year, a Health Station and Barangay Pharmacy has

already been established and is fully operational. At the end of the project, which

is usually three to four years, the people represented by their elected Barangay

Health Committee shall be able to identify health problems, provide solutions to

them or at least help establish linkages with government agencies. Barangay

Health Workers would be able to provide basic primary health care services and

are recognized by the DOH as part of the health team at the municipal level.

(Medical Ambassador Philippines N.D YEAR.)

Primary health care is an approach to health that acknowledges the

determinants of health and the importance of healthy individuals and

communities. It focuses on factors such as where people live, the PRIMARY

HEALTH CARE (2017) state of the environment, education and income levels,

genetics, and relationships with friends and family. It also includes the continuum

of care from pre-conception to end-of-life care, emphasizing health promotion,

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disease and injury prevention, health maintenance, and supporting patients and

families in being partners in their health journey. With patients and families being

core partners on the team, primary health care professionals include family

doctors, family practice nurses, nurse practitioners, pharmacists, social workers,

dietitians, physiotherapists, behaviorists, psychologists and many others, who all

work collaboratively to improve the health and well-being of their patients and

clients. Primary health care is the foundation of the health system, where the

majority of people experience most of their health care, in the community, and is

the ongoing point of contact a person has with the overall health system ( Scotia

Health Authority, 2015 ).

There is increasing evidence in the literature suggesting that PHC is cost-

effective, particularly for interventions associated with improved continuity and

coordination of care and as a result of reduced hospitalizations and emergency

department use (Dahrouge, 2012; McMurchy, 2009; Kringos et al., 2010; Shi,

2012; Barker et al., 2017). Some studies suggest that the correlation between

continuity and reduced hospitalizations for ambulatory care conditions may be

stronger for the highest users of health care (Barker et al., 2017). A recent study

in the United States correlated comprehensiveness of care with reduced health

care expenditures for Medicare beneficiaries (Bazemore et al., 2015), identifying

evidence that supports the importance of comprehensiveness and the assertion

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that comprehensive services in primary care leads to reduced health care costs

(Kringos, 2013).

Philippine Health Insurance

In 2013, the Department of Health, Philippine Health Insurance Corporation

and Department of Science and Technology started the implementation of the

Philippine eHealth Strategic Framework and Program which set the direction for

the adoption of eHealth solutions to health care service standards and services

including that for natural and man-made disasters. These legislative and program

initiatives on health influenced the PHC implementation in the Philippines hence

the need to review the status of PHC in the country REFF

As previously mentioned, the public and social security subsectors should

be approached as a whole, taking into account the reforms initially introduced in

the mid1990s. Since 1995, the NHIP through PhilHealth is a government

mandatory health insurance program that “seeks to provide universal health

insurance coverage and ensure affordable, acceptable, available, accessible,

and quality health care services for all citizens in Philippines” (PhilHealth, 2012).

In France, a recent report concluded that group practices are more

efficient than solo practices for several indicators including, for example,

monitoring of type 2 diabetes patients, vaccination, screening and prevention,

and rates of generic prescribing (Mousques and Daniel, 2015).

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As for unmet needs for a medical examination, high social inequalities

arise in inappropriate visits to EDs. Inappropriate visits to EDs are significantly

higher among the most disadvantaged populations. People living in the most

deprived areas, low-income groups, low-education groups, or ethnic minorities

consistently have a higher risk of unwarranted ED visits (Berchet, 2015)

Ambulatory care sensitive conditions (ACSCs), such as asthma, chronic

obstructive pulmonary disease (COPD), congestive heart failure (CHF) and

diabetes, are conditions for which accessible and effective primary care can

generally reduce the risk of complications and prevent the need for

hospitalization (Purdy et al., 2009, 2012). Potentially avoidable hospitalizations

for these conditions are commonly used to measure access to and quality of

primary care systems (Purdy et al., 2012; Longman et al., 2015; van Loenen et

al., 2014).

To improve accessibility of primary care and limit inappropriate use of

hospital care, EU health systems need to develop primary care services,

especially for emergencies outside normal working hours. Yet a recent policy

survey shows that most (if not all) EU health systems struggle to ensure

comprehensive provision of out-of-hours (OOH) primary care services (Berchet

and Nader, 2016).

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SeveralEUhealthsystemshavealreadydevelopednewcaremodelscentredonpatient

stoaddress the needs of those requiring co-ordination of activities between

providers in various settings. In Belgium, new integrated care models based on

multidisciplinary group practice and a horizontal governance model have been

developed by primary care clinicians since 2016 (Auraaen, forthcoming YEAR).

A 2017 World Bank report concluded that improving nationwide health

outcomes in Haiti will require major investments to reduce the financial and

geographical barriers to accessing primary care. This report validated our

strategy of investing heavily in delivering free primary care to rural communities.

Today, PMPECS covers 8,000 patients in seven Léogâne villages.REFF

According to the United Nations Development Programme's Human

Development Report 2014, in a set of 187 countries, India ranked 135 th on the

human development index, life expectancy at birth was 66.4 years, under-five

mortality rate was 56/1000 live births, and maternal mortality ratio was 200

deaths/100,000 live births, still far behind millennium development goals.(REEF)

Millennium Development Goal

According to the 12th 5-year plan (2012–2017) document, there have

been substantial progresses despite which health-care system suffers from

few weaknesses that are availability of health-care services from public and

private sectors taken together. Qualities of health-care services are not

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uniform throughout public and private sector which may be due to lack or

inadequately enforced regulatory standards. Affordability of health care is a

serious problem as out-of-pocket (OOP) expenditure results in a high financial

burden on families. It has been reported that more than 40% of all patients

admitted to hospital have to borrow money or sell assets, including inherited

property and farmland, to cover expenses, and 25% of farmers are driven

below the poverty line by the costs of their medical care.(REEF)

Currently, only small percentage of population is covered by health

insurances. There is rising burden of non-communicable diseases. Based on

mortality due to non-communicable diseases, projected cumulative loss for

2006–2015 was USD 237 billion.(REEF)

Current set goals outlined in the 12 th 5-year plan are to achieve

reduction of maternal mortality rate to 100, reduction of infant mortality rate to

25, reduction of total fertility rate to 2.1, prevention and reduction of under-

nutrition in children under 3 years to half of the National Family Health

Survey-3 (2005–2006) levels, prevention and reduction of anemia among

women aged 15–49 years to 28%, raising child sex ratio in the 0–6 years age

group from 914 to 950, prevention and reduction of burden of communicable

and non-communicable diseases (including mental illnesses) and injuries,

reduction of poor households’ OOP expenditure.(REEF)

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These goals are realistic and strengthening PHC would be major step

toward achieving such goals. It needs effective planning and future roadmap

to reach the target. PHC forms the anchor around which entire health-care

delivery system is organized. This was evident from the recommendation by

the High-Level Expert Group on Universal Healthcare appointed by the

government of India to allocate 70% of health-care budget for PHC.(REEF)

Seeking to capitalize on the influx of global health funding, in 2000, 189

countries ratified the Millennium Development Goals, initiating an unprecedented

global effort to promote health and well-being across LMIC, largely through

“vertical” programs focused on specific disease or care delivery areas. Since the

conclusion of the Millennium Development Goals in 2015.(REF)

As American health care transitions toward value-based models of care

and payment, successful employers, plans, and health systems are finding

strong primary care to be absolutely essential. Yet the United States spends only

4-8% of health care dollars on primary care, compared to an average of

approximately 12% among other industrialized countries – each of which spends

substantially less per capita on health care than the United States. To build an

American health care system that delivers better care at a lower cost, primary

care must become a national health policy priority.REF

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Although Primary Care: It’s Essential Role in a Value-Based Health Care

System-As American health care transitions from volume to value, successful

employers, plans, and health systems are finding strong primary care to be

absolutely essential. Yet nationally, the United States spends only 4-8% of health

care dollars on primary care, compared to an average of approximately 12%

among other industrialized countries1 - each of which spends substantially less on

health care than the United States. To build an American health care system that

delivers better care at a lower cost, primary care must become a national health

policy priority. REF

NCHC, Health Centers, Physicians Urge Congress to Avoid the 2017

Primary Care Cliff -WASHINGTON, DC – At a Capitol Hill forum yesterday, The

National Coalition on Health Care (NCHC), The National Association of

Community Health Centers (NACHC), and three leading primary care physician

societies urged Congress to avoid an approaching funding cliff for health centers

and workforce programs. “Chronic disease is extremely costly. Primary care is

the affordable.REF

To increase coverage, access and utilization of affordable, comprehensive

and quality preventive, curative and palliative healthcare services. Improve

functionality of primary healthcare clinics and the referral hospital. District,

provincial and central referral hospitals. (2009-2013 Zimbabwe National Health

strategy: Health System strengthening).

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Countries with better Primary Health Care systems reports better

population health outcomes, reduced inequities in population health, and lower

rates of hospitalization resulting in reduced health care costs (Starfield et al.,

2005; Shi, 2012; Freidburg et al., 2010; Kringos et al., 2013; McMurchy, 2009).

Role of Nurses

The nurse practitioner role is transformative in primary health care

delivery, addressing unmet health care needs worldwide. The lack of role

standardization inhibits the nurse practitioner’s ability to cross borders for

meaningful practice and scholarly exchanges, to conduct transnational research,

and transform health care. This lack of standardization is explored from the

perspective of developed and developing countries. One global standard is

advocated to deliver on the vision of primary health care. International nursing

advocacy groups and regulatory bodies are called upon to embrace one global

standard as an opportunity for knowledge transfer across borders and cultures to

improve primary health care (The Journal for Nurse practioners,2015).

Health care reform elements rely on improved integration of care between

the primary and secondary sectors. The objective of this systematic review is to

synthesis the existing published literature on elements of current integrated

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primary/secondary health care. These elements and how they have supported

integrated healthcare governance are presented (BMC Health Research,2013).

In order to build a strong primary health care system, conclusions from the

literature identify that it is important to focus on all attributes (access,

comprehensiveness, continuity, coordination, community oriented) of primary

health care through the implementation of multi-faceted interventions. (Kringos et

al. 2010)

India plans improve public health strengthening primarycare. The Indian

government has announced plans build up country’s healthcare services

strengthening investing primarycare. Health minister J P Nadda stated to

parliament on 10th March, “The draft National Health Policy 2015 envisages

healthcare services being built bedrock high quality comprehensive

primaryhealthcare services universally accessible, free, provided close where

people live work feasible.” (2014Karen R Steingart (University of Washington), Ian

Schiller (McGill University), David J Horne (McGill University), Madhukar Pai

(McGill University), Catharina C Boehme (Foundation for Innovative New

Diagnostics), Nandini Dendukuri (McGill University YEAR).

Networks strengthen health systems chronic disease prevention. Accurate,

rapid detection tuberculosis (TB) TB drug resistance critical improving patient care

decreasing TB transmission. MTB/RIF assay automated test can detect both TB

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rifampicin resistance, generally within two hours after starting test, minimal hands-

on technical time. The World Health Organization (WHO) issued initial

recommendations early 2011. A Cochrane Review diagnostic accuracy pulmonary

TB rifampicin resistance published January 2013. We performed updated

Cochrane Review part WHO process develop updated guidelines use test.

Objectives to assess diagnostic accuracy pulmonary TB (TB detection), where

used both initial test replacing microscopy add-on test following negative smear

microscopy result. To assess diagnostic accuracy rifampicin resistance detection,

where used initial test replacing culture-based drug susceptibility testing (DST).

The populations interest were adults presumed have pulmonary, rifampicin-

resistant multidrug-resistant TB (MDR-TB. The settings interest were

intermediate- peripheral-level laboratories. The latter may associated primary

health care facilities. Search methods they’ve searched publications any language

up 7 February 2013 following databases: Cochrane Infectious Diseases Group

Specialized Register; MEDLINE; EMBASE; ISI Web Knowledge; MEDION;

LILACS; BIOSIS; SCOPUS. We also searched meta-Register Controlled Trials

(mRCT) search portal WHO International Clinical Trials Registry Platform identify

ongoing trials. Selection criteria we included randomized controlled trials, cross-

sectional studies, cohort studies using respiratory specimens allowed extraction

data evaluating against reference standard. We excluded gastric fluid specimens.

The reference standard TB culture rifampicin resistance phenotypic culture-based

DST. Data collection analysis for each study, two review authors independently
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extracted data using standardized form. When possible, we extracted data

subgroups smear HIV status. We assessed quality studies using carried out meta-

analyses estimate pooled sensitivity specificity separately TB detection rifampicin

resistance detection. For TB detection, we performed majority analyses using

bivariate random-effects model compared sensitivity smear microscopy against

culture reference standard. Comparison smear microscopy in comparison smear

microscopy, increased TB detection among culture-confirmed cases 23%. For TB

detection, pooled sensitivity estimates smear microscopy applied hypothetical

cohort 1000 patients where 10% those symptoms have TB, diagnose 88 cases

miss 12 cases, whereas sputum microscopy diagnose 65 cases miss 35 cases.

Rifampicin resistance for rifampicin resistance detection, Xpert® MTB/RIF pooled

sensitivity 95% (95% CrI 90% 97%; 17 studies, 555 rifampicin resistance

positives) pooled specificity 98% (95% CrI 97% 99%; 24 studies, 2411 rifampicin

resistance negatives). For rifampicin resistance detection, pooled accuracy

estimates Xpert® MTB/RIF applied hypothetical cohort 1000 individuals where

15% those symptoms rifampicin resistant, Xpert® MTB/RIF would correctly

identify 143 individuals rifampicin resistant miss eight cases, correctly identify 833

individuals rifampicin susceptible misclassify 17 individuals resistant. Where 5%

those symptoms rifampicin resistant, Xpert® MTB/RIF would correctly identify 48

individuals rifampicin resistant miss three cases correctly identify 931 individuals

rifampicin susceptible misclassify 19 individuals resistant. Authors' conclusions in

adults thought have TB, without HIV infection, Xpert® MTB/RIF sensitive specific.
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Compared smear microscopy, Xpert® MTB/RIF substantially increases TB

detection among culture-confirmed cases. Xpert® MTB/RIF has higher sensitivity

TB detection smear-positive than smear-negative patients. Nonetheless, test may

valuable add-on test following smear microscopy patients previously found smear-

negative. For rifampicin resistance detection, Xpert® MTB/RIF provides accurate

results can allow rapid initiation MDR-TB treatment, pending results from

conventional culture DST. The tests expensive, so current research evaluating

use Xpert® MTB/RIF TB programmes high TB burden settings help evaluate how

investment may help start treatment promptly improve outcomes. (2013Cameron

D. Willis (University of Adelaide), Barbara L. Riley (University of Waterloo), Carol

P. Herbert (University of Western Ontario), Allan Best (University of British

Columbia YEAR).

Social work within healthcare services Barcelona: case studies services

offered people suffering from chronic illnesses. Inter-organizational networks

harness priorities, capacities, skills various agencies individuals have emerged

useful approaches strengthening preventive services public health systems. We

use examples from Canadian Heart Health Initiative Alberta’s Primary Care

Networks illustrate characteristics networks, describe limitations existing

frameworks assessing performance prevention-oriented networks, propose

research agenda guiding future efforts improve performance initiatives.

Prevention-specific assessment strategies capture relevant aspects network

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performance need identified, feedback mechanisms needed make better use data

drive change network activities. (International Journal of Integrated Care 2016

Josefa Rodríguez i Molinet , Olga Alonso Lezcano , Pilar Bañon Zurriaga , Bianca

Beltrán Bartés , Dolors Burrel Buil , Nati Castells Noguero , Rosa Maria Colomer

Campos , Maria Del Rosario Cuesta Alvarez , Lourdes Esteve Mallofré , Mercè Gil

Rovira , Lydia Gómez Martínez , Melinda Jimenez Ibañez , Meritxell Liarte Peruga

, Encarna Martin Robles , Mònica Miró Orpinell , Isabel Molina Gónzalez , Olalla

Montón Lozano , Glòria Obrero Cusidó , Meritxell Ortiz Conca , Raquel Paz

Caballero , Conchita Peña Gallardo , Graciela Pereira Pereira , Aina Plaza Tesias

, Jordi Valls Llenas. YEAR)

Furthermore, Understanding gap between need utilization out-patient care

—the effect supply-side determinants regional inequities. The contribution social

factors genesis evolution health problems people well importance social family

support protective factor health have been extensively studied various scientific

forums. This evidence highlights need addressing social problems health social

workers training, widely field present each assistive devices provide health care

population. It should work problems social functioning health-altering, those health

problems impair social functioning people environment. The Health Consortium

Barcelona, line Program Prevention attention chronicity Generalitat de Catalunya,

has group social workers different levels care (hospitals, primary health care,

health centers, home care teams , mental health, care homes, drug dependence)

city Barcelona, meet aim promoting defending importance social factors care
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chronically ill clarify strengthen its role. After two years work, group reflected

professional role relation chronicity reading discussion articles documents, well

analysis experience members each device, creating consensus document which

identify each every one services offered citizens. They conclude general, all

health social workers any assistance device offered population common services

(proactive detection, medical social diagnosis, plan work, social treatment, group

care, coordination networking, community health promotion volunteering,

participation welfare committees research teaching). And specifically, each health

worker, offering differentiated according level care (hospital, primary care,

geriatric), being widely detailed portfolio services developed group. Overall, work

offers vision care continuum, line Cross health care social work, which appears

takes over care any health care device providing continuous support patient

family, regardless path chronically ill do. Accompaniment, when required, should

coordinated connect other community services help complete comprehensive

care chronic patient family reality. The results work have been: - The creation

portfolio health consensual social work city Barcelona attention chronicity. - The

commissioning relationship between different levels care professionals providers

(public private) increasing trust allowing establishment new synergies.

Strengthening role develops social work health chronicity our city. The

empowerment health worker management your organization, promoting

participation new care programs chronicity. Improving continuum care person

environment. Possible areas improvement research advance social care some

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populations displayed; children chronic disease, people addictions family violence

situations. In short, provides, result research, reflection consensus, first series

future instruments allow guide citizens, institutions, managers professionals

important task develop health worker city Barcelona. (HEALTH POLICY 2014

Susanne Ozegowski (Department of Health Care Management, Berlin University

of Technology), Leonie Sundmacher (Department of Health Care Management,

Berlin University of Technology,YEAR).

Related Studies

In addition, association processes primary care hospitalisation people

diabetes. The present study analyses effect supply-side determinants regional

inequities outpatient care. Inequities measured degree disparity between need

actual utilization outpatient health services 412 German districts. Outpatient care

needs each district determined applying regression model German risk structure

compensation scheme. We find supply-side factors account half model's coverage

regional inequities. The remaining regional variance explained model may

attributed socioeconomic socio-geographic determinants well price effects. Our

findings call strengthening role GPs coordinators health care system, countering

geographic mal-distribution physicians introducing adequate programs improve

level care socially deprived districts. The study also highlights importance

differentiating between need, demand utilization health services order understand

root causes inequities. (Diabetes Research and Clinical Practice 2015 Elizabeth

Jean Comino (University of New South Wales), Fakhrul Islam (University of New
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South Wales), Duong Thuy Tran (University of New South Wales), Louisa Jorm

(University of New South Wales), Jeff Flack (University of New South Wales), Bin

Jalaludin (University of New South Wales), Marion Haas (University of

Technology, Sydney), Mark Fort Harris (University of New South Wales,YEAR).

Likewise, China undergoing major health system reforms, aim providing

universal health coverage, addressing problems low efficiency inequity. The first

phase reforms has focused strengthening primary care improving health

insurance coverage benefits. The aim study explore impacts reforms health

workers service-users township level, which has been major target first phase

reforms. From January March 2013 we interviewed eight health officials, 80

township health workers 80 service-users eight counties Zhejiang Yunnan

provinces, representing rich poor provinces respectively. Thematic analysis

identified key themes around impacts health reforms. We found some elements

reforms may actually undermining primary care. While new health insurance

system popular among service-users, criticised contributing fast-growing medical

costs, imbalance benefits between outpatient inpatient services. Salary reform

has guaranteed health workers' income, greatly reduced incentives. The essential

drug list removed perverse incentives overprescribe, led falls income health

workers, loss autonomy doctors. Serious problems drug procurement also

emerged. The unintended consequences have included brain drain experienced

health workers from township hospitals, patients have flowed county hospitals

greater cost. In conclusion, short term resources must found ensure rural health
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workers feel appropriately remunerated have more clinical autonomy, measures

containment medical costs must be taken, drug procurement must show

increased transparency accountability. More importantly study shows all countries

undergoing health reforms should elicit views stakeholders, including service-

users, avoid address unintended consequences. (2016Oriol Garcia-Codina ,

Paloma Amil Bujan , Dolors Juvinyà-Canal , Assumpció Gonzalez Mestre , Eulàlia

Masachs-Fatjó , Esteve Saltó Cerezuela , Carles Blay Pueyo (Generalitat of

Catalonia, YEAR).

In addition, health system reform rural China: Voices health workers

service-users. Strengthening primary health care (PHC) is considered a priority for

efficient and responsive health systems, but empirical evidence from low- and

middle-income countries is limited. The stepwise introduction of family medicine

across all 81 provinces of Turkey (a middle-income country) between 2005 and

2010, aimed at PHC strengthening, presents a natural experiment for assessing

the effect of family medicine on health service utilization and user satisfaction.

The effect of health system reforms that introduced family medicine on utilization

was assessed using longitudinal, province-level data for 12 years and multivariate

regression models adjusting for supply-side variables, demographics, socio-

economic development and underlying yearly trends. User satisfaction with

primary and secondary care services was explored using data from annual Life

Satisfaction Surveys. Trends in preferred first point of contact (primary vs

secondary, public vs. private), reason for choice and health services issues, were
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described and stratified by patient characteristics, provider type, and rural/urban

settings. Between 2002 and 2013, the average number of PHC consultations

increased from 1.75 to 2.83 per person per year. In multivariate models, family

medicine introduction was associated with an increase of 0.37 PHC consultations

per person (P<0.001), and slower annual growth in PHC and secondary care

consultations. Following family medicine introduction, the growth of PHC and

secondary care consultations per person was 0.08 and 0.30, respectively, a year.

PHC increased as preferred provider by 9.5% over 7 years with the reasons of

proximity and service satisfaction, which increased by 14.9% and 11.8%,

respectively. Reporting of poor facility hygiene, difficulty getting an appointment,

poor physician behaviour and high costs of health care all declined (P < 0.001) in

PHC settings, but remained higher among urban, low-income and working-age

populations. (Social Science & Medicine 2014 Xu Dong Zhou (Zhejiang

University), Lu Li (Zhejiang University), Therese Hesketh (UCL Institute for Global

Health,YEAR)

Furthermore strengthening capacity manages pharmaceutical services

based Primary Health Care (PHC) different levels health system. The World

Health Organization describes health literacy cognitive social skills which

determine motivation ability individuals gain access to, understand use

information ways which promote maintain good health. Health literate individuals

have skills keep healthier themselves maintain quality life longer. In ageing

societies, where chronic conditions expected keep growing while resources

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remain stable, health literacy one keys challenges facing community health

beginning XXI century. The Health Plan Catalonia (HPC) indicative instrument

framework all public programs field Health Ministry Government Catalonia. The

main 2020 goal HPC increase healthy life expectancy, is, proportion years good

self-perceived health status. This objective aligns purpose promoting more health

literate societies. Methods: During 2014 health survey Catalonia (HSC) included

short version European Health Literacy Survey Questionnaire. HSC official survey

provides information health status, life styles use health services Catalonia’s

population. 3.642 people aged 15 over answered questionnaire. HLS-EU-Q16

shortened version questionnaire HLS-EU-Q47, developed European Health

Literacy Project 2009-2012, which administered eight different countries. As

longer version, HLS-EU-Q16 assumes multidimensional concept health literacy,

which helps identify health literacy profiles individuals, also populations. A

descriptive analysis socio-demographic characteristics, health status health

service use (% CI95%) performed according health literacy level people. Results:

Results show proportion people insufficient health literacy (either problematic

inadequate health literacy levels) higher among people aged 65 over, among

people who attained primary education below, among people who belong lower

social classes. On other hand, people without sufficient health literacy show worse

perception health status, declare chronic conditions have disabilities higher

proportion than those who have sufficient health literacy levels. Regarding use

health services, people problematic inadequate health literacy levels attend GP,
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consume medicines go emergency department more frequently than people

sufficient health literacy. Discussion: The WHO global strategy person-centred

integrated health care services establishes empowering engaging every individual

communities its first strategic goal. Promotion health literacy about providing

resources abilities empower individuals communities also about adapting health

care systems needs people. Results show some people would face more

difficulties than expected had perform health related activities. On other hand,

health literate people enjoy more autonomy when dealing activities related health

information. In order advance towards much more integrated person-centred

health care services, health literacy levels should be taken account promotion

health literacy population, individual health care services desirable. Conclusion:

Several difference arise health status health care service use arise according

health literacy level people. These results starting point designing strategy health

literacy Catalonia, which help design interventions aimed strengthening promoting

health literacy, also person-centred health care services. (Human Resources for

Health 2014 Isabel Cristina Martins Emmerick (Oswaldo Cruz Foundation), Luisa

Arueira Chaves (Oswaldo Cruz Foundation), Nelly Marin (Oswaldo Cruz

Foundation), Vera Lucia Luiza (Oswaldo Cruz Foundation, YEAR).

In Addition, strengthening health systems accelerate achievement

Millennium Development Goals: case study Ketu South Keta Municipalities

Ghana: original research article. Distance learning methods have been widely

used because advantages continuing professional development processes. The

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Primary Health Care (PHC) strategy which has been implemented order improve

efficiency health systems. Due need access medicines technologies regardless

strengthening health systems, new approach better integrates both

pharmaceutical services health systems has been implemented. Case description:

This case study which consists describing process restructuring, developing

implementing second version Virtual Course Primary Health Care-based

Pharmaceutical Services managers. The main objective strengthen capacity

managers pharmaceutical services, based PHC different levels health system,

order support restructuring empowering services and, consequently, health

systems American region. Discussion evaluation: Many evaluation tools were

applied identify achievement/improvement planned competencies. The

intervention proposals were collectively built intended more than academic

exercise, looking forward being implemented strategic intervention promote

changes pharmaceutical services American region. The main strengths identified

second version course were related quality didactic material content. Additionally,

tutors’ support commented upon positive aspect. The main challenges faced

rebuilding process related due date activities lectures well time capture assimilate

content. Conclusions: The consistent issues raised pilot course’s evaluation 2011,

which were successfully implemented. The use distance learning strategy,

through virtual environment, application Virtual Course PHC- based

pharmaceutical services managers, appropriate confirmed its role public policy

promotion through effective retention distribution health workers. (African Journal

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of Reproductive Health 2015 Farouk Adam Iddrisu , Sarita Dhakal (Yonsei

University), Eun Woo Nam (Yonsei University).

Furthermore, strengthening district health service management delivery

through internal contracting: lessons from pilot projects Cambodia. This study

aims determine means strengthening health system accelerate achievement

MDGs 4 5 Volta Region Ghana, particular emphasis Ketu South Keta

municipalities. Secondary data have been used study. High maternal infant

mortality crucial issue Ghana. Maternal infant mortality high rural area compared

urban area due unavailability service facilities. A community based health

planning services programs have been established improve access quality health

care Ghana. Our study suggests health system strengthening community health

care programs improved access quality health care resulted decrease maternal

child mortality Ketu South Keta Municipalities Ghana. (Social Science & Medicine

2013 Keovathanak Khim (University of Melbourne), Peter Leslie Annear

(University of Melbourne)

Following decade piloting different models contracting, mid-2009

Cambodian Ministry Health began test form ‘internal contracting’ health care

delivery selected health districts (including hospitals health centers) contracted

provincial health department Special Operating Agencies (SOAs) provided greater

management autonomy. This study assesses internal contracting approach

means improving management district health services strengthening service

delivery. While study may contribute emerging field now known performance-
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based financing, lessons deal more broadly impact management reform

increased autonomy contrast traditional public sector line-management budgeting.

Carried out during 2011, study based on: (i) review literature operational

documents; (ii) primary data from semi-structured key informant interviews 20

health officials two provinces involved four SOA pilot districts; (iii) routine data

from 2011 SOA performance monitoring report. Five prerequisites were identified

effective contract management improved service delivery: clear understanding

roles responsibilities contracting parties; implementation clear rules procedures;

effective management performance; effective monitoring contract; adequate

timely provision resources. Both level allocation incentives management

bottlenecks various levels continue impede implementation. We conclude that,

contracted arrangements like these, clear separation contracting functions

(purchasing, commissioning, monitoring regulating), management autonomy

where responsibilities genuinely devolved accepted, provision resources

adequate meet contract demands necessary conditions success. The impact

unmet eye care needs sub-Saharan Africa compounded barriers accessing eye

care, limited engagement communities, shortage appropriately skilled health

personnel, inadequate support from health systems. The renewed focus primary

health care has led support greater integration eye health national health

systems. The aim paper demonstrate available evidence integration eye health

primary health care sub-Saharan Africa from health systems strengthening

perspective. (BMC Health Services Research [IF: 1.83] 2013 Rènée du Toit ,
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Hannah B Faal , Daniel Etya’ale (International Agency for the Prevention of

Blindness), Boateng Wiafe (MSC Industrial Direct Company, Inc.), Ingrid Mason

(Cambrex Corporation), Ronnie Graham , Simon Bush (MSC Industrial Direct

Company, Inc.), Wanjiku Mathenge (The Fred Hollows Foundation), Paul

Courtright (Tumaini University Makumira).

South African Department Health adopted scaled-up love Life’s Youth

Friendly Services (YFS) initiative national policy improve youth utilization health

programmes strengthening community sensitisation counselling services. As

services roll-out, alternative services target young people also becoming more

popular. Success any services, however, dependent upon young people’s

perceptions health services whole. This aims examine knowledge perceptions

current health services oriented towards young people examine potential

alternative approaches health service delivery. (BMC HEALTH SERVICES

RESEARCH 2014 Brittany Schriver (Department of Global Health, Rollins School

of Public Health), Kathryn Meagley (Department of Behavioral Sciences and

Health Education, Rollins School of Public Health), Shane A. Norris (MRC/Wits

Developmental Pathways for Health Research Unit, Department of Paediatrics),

Rebecca Geary (Department of Population Studies, Faculty of Epidemiology and

Population Health), Aryeh D. Stein (MRC/Wits Developmental Pathways for

Health Research Unit, Department of Paediatrics).

 Pamantasan ng Cabuyao
COLLEGE OF NURSING
Operationalizing Adolescent Health Services Primary Health Care Level

India: Processes, Challenges Outputs Ministry Health, Government India

developed Adolescent Reproductive Sexual Health (ARSH) strategy

operationalized adolescent health services up district sub-district hospital level.

Objectives: To operationalize adolescent health services primary health care level

block Maharashtra; assess impact need based interventions quality services;

understand potential scalability state. Methods: Adolescent Youth friendly centers

were established primary health care settings interventions health system

strengthening, sensitizing gatekeepers, involving Accredited Social Health Activist

(ASHAs), developing inter intra-sectoral linkages, improving monitoring evaluation

were tested. Results: Over period 2009-2014, steady increase number clients

attending Adolescent Youth Friendly Health Centers (AY has limitations terms its

reach adolescents generating demand services. There need network education

sector, ICDS, NGOs working adolescent health development work team address

multifaceted needs adolescents. Such strategy crucial while implementing

recently launched Rashtriya Kishor Swasthya Karyakram— new national

adolescent health programme India. 2017 Beena Nitin Joshi (National Institute for

Research in Reproductive Health), Sanjay Laxman Chauhan (National Institute for

Research in Reproductive Health), Ragini Nitin Kulkarni (National Institute for

Research in Reproductive Health), Babita Kamlapurkar , Rajesh Mehta.? REF

The next level integrated care Germany. The lack integration health-care

sectors specialist groups widely accepted necessity effectively address most

 Pamantasan ng Cabuyao
COLLEGE OF NURSING
urgent challenges modern health care systems. Germany follows more

decentralized approach allows many degrees freedom. With its latest bill, German

government has introduced several measures explicitly foster integration health-

care services. This article presents historic development integrated care services

offers insights construction integrated care programs German health-care system.

The measures integrated care within Health Care Strengthening Act presented

discussed detail from perspective provider, payer, and political arena. In addition,

effects new act assessed using scenario technique based analysis effects

previously implemented health policy reforms. Germany now has flourishing

integrated care scene many integrated care programs being able contain costs

improve quality. Although still long journey Germany reach coordination care

standards set leading countries United Kingdom, New Zealand Switzerland,

international health policy makers may deliberately selectively adopt elements

German approach extensive freedom contract, strong patient-focus allowing very

need-driven regional solutions, substantial start-up funding allowing more

unproven progressive endeavors further improve own health systems. (2016

Ricarda Milstein (University of Hamburg), Carl Rudolf Blankart (University of

Hamburg,YEAR).

In addition, indigenous Primary Health Care (PHC) services participating

Continuous Quality Improvement (CQI) cycles show varying patterns performance

over time. Understanding variation essential scaling up sustaining quality

improvement initiatives. The aim study examine trends quality care services
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participating ABCD National Research Partnership describe patterns change over

time; examine health service characteristics associated positive negative trends

quality care. Setting participants PHC services providing care Indigenous people

urban, rural remote northern Australia had completed least three annual audits

least one aspect care. Methods/Design Longitudinal clinical audit data from use

four clinical audit tools (maternal health, child health, preventive health, and Type

2 diabetes) between 2005 - 2013 were analysed. Health center performance

classified six patterns change over time: consistent high improvement (positive),

sustained high performance (positive), decline (negative), marked variability

(negative), consistent low performance (negative), specific increase decrease

(neutral). Backwards stepwise multiple logistic regression analyses were used

examine associations between health service characteristics positive negative

trends quality care. Results Trends quality care varied widely between health

services across four audit tools. Regression analyses health service

characteristics revealed consistent statistically significant association population

size, remoteness, governance model accreditation status positive negative trends

quality care. Conclusions the variable trends quality care reflected CQI audit tools

do appear related easily measurable health service characteristics. This points

need deeper more nuanced understanding factors moderate effect CQI health

service performance purpose strengthening enablers overcoming barriers

improvement. (2016 Sarah Larkins (James Cook University), Cindy E. Woods

(James Cook University), Veronica Matthews (Charles Darwin University), Sandra

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COLLEGE OF NURSING
C. Thompson (University of Western Australia), Gill Schierhout (University of New

South Wales), Maxwell Mitropoulos (University of Queensland), Tania Patrao ,

Annette Panzera (James Cook University), Ross Stewart Bailie (University of

SydneyYEAR).

Furthermore, maternal morbidity and mortality remains high Uganda;

largely due inadequate antenatal care (ANC), low skilled deliveries poor quality

other maternal healthservices. In order address both demand quality ANC skilled

deliveries, we introduced community mobilization health facility capacity

strengthening interventions. (2013 Michael Ediau (Makerere University), Rhoda K

Wanyenze (Makerere University), Simba Machingaidze , George Otim , Alex

Olwedo , Robert Iriso (Baylor College of Medicine), Nazarius M Tumwesigye

(Makerere UniversityYEAR).

The health care system Serbia based network public health institutions

funded National Health Insurance from state budget. Access public health

institutions free. Preventive curative services provided local level primary health

care centers. Over past 5-7 years, number pediatricians primary health care

centers decreased because reduced number applicants pediatric training, which

endangers maintenance traditional model pediatric care. Secondary medical care

offered pediatric departments local regional general hospitals outpatient clinics,

specialized hospitals children adults. Tertiary medical care provided inpatient

outpatient subspecialty services 5 major university children's clinics. The health

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reforms undertaken recent 10 years have aimed strengthening preventive health

care reducing overall costs pediatric care. Current initiatives Ministry Health and

national pediatric associations aimed re-establishing strengthening capacity

primary pediatric health care model increasing number physicians developing new

processes care. (2016 Radovan Bogdanović, Dragana Lozanović , Milica Pejović

Milovančević (University of Belgrade, Ljiljana Sokal Jovanović YEAR.)

In addition, Bangladesh Government introduced National Nutrition Services

(NNS) leveraging existing health infrastructure deliver nutrition services pregnant

woman children. This study examined quality nutrition services provided during

antenatal care (ANC) management sick children younger than five years.

Methods Service delivery quality assessed across three dimensions; structural

readiness, process outcome. Structural readiness assessed observing presence

equipment, guidelines register/reporting forms ANC rooms consulting areas sick

children 37 primaryhealthcare facilities 12 sub-districts. In addition, training

knowledge relevant nutrition service delivery 95 healthcare providers determined.

The process nutrition service delivery assessed observing 381 ANC visits 826

sick children consultations. Satisfaction service outcome determined interviewing

541 mothers/caregivers sick children.Results Structural readiness provide

nutrition services higher ANC compared management sick children; 73% ANC

rooms had >5 13 essential items while only 13% designated areas management

sick children had >5 13 essential items. One five (19%) healthcare providers had

received nutrition training through NNS. Delivery nutrition services poor: <30%
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COLLEGE OF NURSING
women received all four key antenatal nutrition services, 25% sick children had

weight checked against growth-chart <1% had height measured. Nevertheless,

most mothers/caregivers rated satisfaction service above average.Conclusions

strengthening provision equipment increasing coverage training imperative

improve nutrition services. Inherent barriers implementing nutrition services

primary healthcare, especially high caseloads during management sick under-five

children, should considered identify alternative appropriate service delivery

platforms before nationwide scale up. (2017 Sk Masum Billah (International

Centre for Diarrhoeal Disease Research, Bangladesh), Kuntal Kumar Saha

(International Centre for Diarrhoeal Disease Research, Bangladesh), Abdullah

Nurus Salam Khan (International Centre for Diarrhoeal Disease Research,

Bangladesh), Ashfaqul Haq Chowdhury (University of Minnesota), Sarah P.

Garnett (University of Sydney), Shams El Arifeen (International Centre for

Diarrhoeal Disease Research, Bangladesh), Purnima Menon (International Food

Policy Research Institute).

Health Care Sectors

The lack integration health-care sectors specialist groups widely accepted

necessity effectively address most urgent challenges modern health care

systems. Germany follows more decentralized approach allows many degrees

freedom. With its latest bill, German government has introduced several

measures explicitly foster integration health-care services. This article presents

historic development integrated care services offers insights construction

 Pamantasan ng Cabuyao
COLLEGE OF NURSING
integrated care programs German health-care system. The measures integrated

care within Health Care Strengthening Act presented discussed detail from

perspective provider, payer, and political arena. In addition, effects new act

assessed using scenario technique based analysis effects previously

implemented health policy reforms. Germany now has flourishing integrated care

scene many integrated care programs being able contain costs improve quality.

Although still long journey Germany reach coordination care standards set leading

countries United Kingdom, New Zealand Switzerland, international health policy

makers may deliberately selectively adopt elements German approach extensive

freedom contract, strong patient-focus allowing very need-driven regional

solutions, substantial start-up funding allowing more unproven progressive

endeavours further improve own health systems. ( Ricarda Milstein (University of

Hamburg), Carl Rudolf Blankart (University of Hamburg,2016).

Lack care coordination identified major cause poor quality healthservices,

associated higher costs, duplication overuse diagnostic procedures, use multiple

medicines, conflicting therapies, chronic conditions suffering greatest negative

impact. Coordination presupposes organizing patient care, which may involve two

more providers users themselves, order facilitate timely provision services,

involving planning related staff other resources instruments information exchange

between providers. Organizational elements ensure coordination should include

definition shared goals health system; financial incentives via disbursement

allocation resources; communication mechanisms between health professionals;

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development common culture leadership oriented towards teamwork,

collaboration better performance; strengthening care model based Primary Health

Care (PHC) .Different contexts must considered, since broadly developed

definition. The Political National de Atencao Basica (PNAB – National Primary

Care Policy) defines coordination “coordination integrity,” one basis PHC, which

should enabled means horizontal integration strategies (programmatic action

spontaneous demand, surveillance care initiatives, multidisciplinary

interdisciplinary work) vertical integration strategies between different levels

Healthcare Networks. In Brazil, studies suggest integration Healthcare Networks,

one dimensions coordination, has been strengthened expansion Family Health

Strategy; creation specialized services health districts; introduction regulatory

system; computerization medical records; development management clinical

protocols; initiatives communication technical support. In article, care coordination

understood interaction between various services, actions professionals related

health care ensure always synchronized focused achieving common goal,

regardless where provided. It supported existence integrated action between

providers different levels within same level, so different interventions perceived

experienced users manner continuous appropriate health needs. This article

sought examine breadth care coordination PHC regionalized networks. It aims

contribute new elements debating issue context health regions, given lack

research proposing investigate coordination circumstances require horizontal

integration between same-level professionals services providers, based PHC

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strong essential attributes, vertical integration between network services managed

different state agencies. Therefore, analyzing facilitating devices barriers

coordination regional areas may indicate paths achieve timelier higher quality

access Brazilian Unified Health System (SUS). (2016 Patty Fidelis de Almeida

(Federal Fluminense University), Adriano Maia dos Santos (Federal University of

Bahia YEAR).

Synthesis

To address these issues, reform in the country’s health care system

have been instituted in the past 30 years. Several laws, executive orders and

policy issuances have addressed and are addressing these issues. Some of

these are the following: Adoption of Primary Health Care, Integration of public

health and hospital services in 1983 by virtues of Executive Order 851,

Generics Act of 1988 (RA 6675) , Local Government Code of 1991 (RA 7160)

, National Health Insurance Act of 1995 (RA 7875).

The Senate and the House of Representative in Congress enacted, An

Act Providing A Local Government Code of 1991 (Republic Act No. 7160) this

code establishes and defines power of provincial city, municipals. It provides

more responsive local government structure insituted through system of

decentralization. It provides genuine and meaningful autonomy to the local

government. This shall enable them to attain their fullest development as well

as to be self-reliant communities. The Code gives them more powers,

authority, responsibilities and resources. The Code requires all national

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government agencies to conduct regular consultations with local government

units especially before any national program or project is implemented in the

local community. Community participation, collaboration and consultations at

all levels are encouraged, from planning of any health initiative to resource

sharing to actual implementation and monitoring and evaluation. Public-

private cooperation is needed and encouraged. These activities are

important, even an imperative especially in the delivery of the basic services.

The Code also allows the LGUs to negotiate and secure grants for their

programs and projects. The organized Local Health Boards (LHB) – city,

municipal, province – provide the venue for discussions, advocacies,

advisories regarding the fiscal requirements needed to operate and maintain

the local health system operations. Through this forum, inter-local health

zones of health development may be created. The Local Government Code

(RA No. 7160) provides the legal framework for the process of coordination of

all health efforts in the local community (DOH, 2008).

The following were program and projects of LGU 1.) Facilitate the

Expansion of the National Health Insurance Program (NHIP) A) Support the

Attainment of Universal Coverage for Social Health Insurance Social

marketing strategies shall be conducted among the LGUs to increase the

enrolment of the indigent families to the Sponsored Program of the NHIP. The

LGUs shall also assist in the implementation of social marketing strategies to

increase the enrolment of the informal sector to the NHIP (DOH, 2008).
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B) Ensure Local Government Premium Counterpart The municipal, city

and provincial LGUs shall ensure the allocation of budget from their IRA for

the payment of their premium counterpart in the enrolment of indigent families

to the Sponsored Program of PhilHealth. The LGUs may pursue legislation to

peg a portion of their Internal Revenue Allotment (IRA) to enroll the indigents

identified in the tool for identification of the poor (DOH, 2008).

C) Adoption of PhilHealth Approved Tool/s for Identifying Indigent

Families The LGUs shall adopt the PhilHealth approved tool for identifying

indigent families for enrolment into the Sponsored Program of PhilHealth to

ensure that the true poor families will be given financial risk protection from

catastrophic illnesses through social health insurance (DOH, 2008).

D) Hasten PhilHealth Accreditation of Facilities The municipal, city and

provincial LGUs shall ensure that their facilities such as the RHUs and

hospitals shall meet the accreditation criteria of PhilHealth for them to qualify

for the release of capitation and reimbursement from PhilHealth (DOH, 2008).

E) Rational use of PhilHealth Capitation and Reimbursement The

municipal and city LGUs shall ensure that capitation from PhilHealth shall be

spent rationally following PhilHealth policies for its utilization. The hospitals of

LGUs shall also ensure that they are claiming appropriate reimbursement

from PhilHealth based on benefit packages and treatment guidelines and that

the reimbursements are properly utilized according to PhilHealth policy (DOH,

2008).
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2. Increase in LGU Investments for Health A) Increase Budget

Allocation for Health Advocacy for the increased health budget allocation for

capital outlay, maintenance and other operating expenses (MOOE) and

personal services from the IRA shall be conducted among municipal, city and

provincial LGUs (DOH, 2008).

B) Revenue Generation and Mobilization of Extra-Budgetary

Resources resources for health such as collection of user-fee charges in

health facilities without compromising the access of the poor and through the

rationalized use of real property assets of health facilities such as

establishment of income generating projects and economic enterprise within

their areas of responsibility (DOH, 2008).

As of 2011, the LGU of City of Cabuyao created “City Ordinance of

No. 2011-340” that stated prohibiting of drinking and selling of alcoholic

beverages beside the street or road. In the year of 2012 LGU implemented

“City Ordinance of no. 2012-356” mandatory for lying-in clinics to accredit the

PHILHEALTH insurance corporation before granting the permit to operate .

Last 2013, the City of Cabuyao mandated “City Ordinance No. 2013-

384” stating that force evacuation as resort when disaster or emergency has

been declared in the municipality and danger of loss of lives. In same year

LGU implemented “City Ordinance No. 2013-395” stating that maintaining

PHILHEALTH trust fund from the proceeds of the primary care benefit 1 and
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“City Ordinance No. 2013-405” is implementation of national policies and plan

of actions governing infant and young child feeding in the City of Cabuyao.

For year 2014, City of Cabuyao implemented “City Ordinance No.

2014-416 An Ordinance Providing for the City of Cabuyao Women and

Children protection”. In same year the City of Cabuyao implemented “City

Ordinance No. 2014-429 An Ordinance creating the City TB Council” as a

vehicle to consolidate and unify efforts towards a community. In year 2015,

“City Ordinance No. 2015-432” created. This was ordinance for providing for

the City of Cabuyao citizens code of 2015, the code has following policies: A)

Motivate and encourage the senior citizens to contribute to nation building. B)

Encourage their families and communities they live with to reaffirm the valued

Filipino tradition of caring for the senior citizens. In current year, City of

Cabuyao mandated “City Ordinance No. 2015-438 An Ordinance Establishing

the DOH Guidelines on Basic Emergency Obstetric and Newborn Care

(BEMONC) and Maternal and Child Health Nutrition (MNCHN) Services (for

PHILHEALTH members) in the City of Cabuyao.

Last year 2016, City of Cabuyao implemented “City Ordinance No.

2016-456 An Ordinance Institutionalizing the Botika ng Cabuyao”, as local

public enterprise and adopting the medicine consignment system. In current

year, the “City Ordinance No. 2017-501 Implemented it is An Ordinance

Criminalizing Specific Anti-Social Behaviors”, prescribing penalties thereof

and for other purposes. In current year the City of Cabuyao created “City
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Ordinance No. 2017-503 An Ordinance Promoting a Drug-Free Workplace in

the City Government of Cabuyao” providing sanctions thereof.

On the basis of President Noynoy Aquino’s Universal Health Care (UHC)

program, government funding for health has increased substantially. In 2008, the

DOH budget was just under P19B which increased slightly to almost P24B in

2009. When PNoy took office in 2010, the DOH budget was about P25B. The

2014 DOH budget is almost P90B (DOH, 2012).

In relation to PhilHealth, there has been a 65% increase in enrolment

among the poor. As of 2012, 82.4M Filipinos of the 95.8 M projected population

for that year have been enrolled in PhilHealth, a coverage rate of about 86%.

(DOH, 2012)

As per the DOH, from 2010 to February 2013, more than 3,500 public

health facilities across the archipelago were upgraded and rehabilitated. These

include hospitals, rural health units and barangay health stations. For the

remainder of 2013, an additional 2,487 health facilities were upgraded (DOH,

2013).

In accordance through Doctors to The Barrios and RN Heals programs, the

DOH is deploying more doctors and nurses in underserved rural areas. The DOH

is entering into Public-Private Partnerships (PPP) to modernize government

hospitals and build new, modern health facilities (DOH, 2012).

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An efficient healthcare system delivers reasonable access to quality care

regardless of an individual’s capabilities to spend while guaranteeing them

against the monetary effects of poor health, according to World Health

Organization. Primary Health Care is a multi-dimensional system that has a

responsibility to organize care for individual for continuum of care and understand

and work with our partners to improve the health of communities. Primary health

care is a philosophy for organizing and delivering a range of coordinated and

collaborative community-based services that empower individuals, families and

communities to take responsibility for their health and well-being. Effective primary

health care requires a culture and system designed to be responsive to individual

and population health needs.

Like many other country China undergoing major health system reforms,

aim providing universal health coverage, addressing problems low efficiency

inequity. The first phase reforms has focused strengthening primary care

improving health insurance coverage benefits. The aim study explore impacts

reforms health workers service-users township level, which has been major target

first phase reforms. From January March 2013 we interviewed eight health

officials, 80 township health workers 80 service-users eight counties Zhejiang

Yunnan provinces, representing rich poor provinces respectively. Thematic

analysis identified key themes around impacts health reforms. We found some

elements reforms may actually undermining primary care. While new health
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insurance system popular among service-users, criticised contributing fast-

growing medical costs, imbalance benefits between outpatient inpatient services.

Salary reform has guaranteed health workers' income, greatly reduced incentives.

The essential drug list removed perverse incentives overprescribe, led falls

income health workers, loss autonomy doctors. Serious problems drug

procurement also emerged. The unintended consequences have included brain

drain experienced health workers from township hospitals, patients have flowed

county hospitals greater cost. In conclusion, short term resources must found

ensure rural health workers feel appropriately remunerated have more clinical

autonomy, measures containment medical costs must be taken, drug

procurement must show increased transparency accountability.

In addition health system reform rural China: Voices health workers

service-users. Strengthening primary health care (PHC) is considered a priority for

efficient and responsive health systems, but empirical evidence from low- and

middle-income countries is limited. The stepwise introduction of family medicine

across all 81 provinces of Turkey (a middle-income country) between 2005 and

2010, aimed at PHC strengthening, presents a natural experiment for assessing

the effect of family medicine on health service utilization and user satisfaction.

The effect of health system reforms that introduced family medicine on utilization

was assessed using longitudinal, province-level data for 12 years and multivariate

regression models adjusting for supply-side variables, demographics, socio-

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economic development and underlying yearly trends. User satisfaction with

primary and secondary care services was explored using data from annual Life

Satisfaction Surveys. Trends in preferred first point of contact (primary vs

secondary, public vs. private), reason for choice and health services issues, were

described and stratified by patient characteristics, provider type, and rural/urban

settings. Between 2002 and 2013, the average number of PHC consultations

increased from 1.75 to 2.83 per person per year. In multivariate models, family

medicine introduction was associated with an increase of 0.37 PHC consultations

per person (P<0.001), and slower annual growth in PHC and secondary care

consultations. Following family medicine introduction, the growth of PHC and

secondary care consultations per person was 0.08 and 0.30, respectively, a year.

PHC increased as preferred provider by 9.5% over 7 years with the reasons of

proximity and service satisfaction, which increased by 14.9% and 11.8%,

respectively.

The Health Care Strengthening Act: The next level integrated care

Germany. The lack integration health-care sectors specialist groups widely

accepted necessity effectively address most urgent challenges modern health

care systems. Germany follows more decentralized approach allows many

degrees freedom. With its latest bill, German government has introduced several

measures explicitly foster integration health-care services. This article presents

historic development integrated care services offers insights construction

 Pamantasan ng Cabuyao
COLLEGE OF NURSING
integrated care programs German health-care system. The measures integrated

care within Health Care Strengthening Act presented discussed detail from

perspective provider, payer, and political arena. In addition, effects new act

assessed using scenario technique based analysis effects previously

implemented health policy reforms. Germany now has flourishing integrated care

scene many integrated care programs being able contain costs improve quality.

Although still long journey Germany reach coordination care standards set leading

countries United Kingdom, New Zealand Switzerland, international health policy

makers may deliberately selectively adopt elements German approach extensive

freedom contract, strong patient-focus allowing very need-driven regional

solutions, substantial start-up funding allowing more unproven progressive

endeavours further improve own health systems.

According to Allianz 2018 the healthcare system in the Philippines is a

mixed public-private system. Public health care is organized in 2 tiers: Primary

care is delivered through public health and primary health care centers linked to

peripheral barangay health centers (BHCs) or health outposts. Private healthcare

services are well-established and growing in Philippines through specialist clinics

and private hospitals. The private sector is much larger than the public sector in

terms of human, financial and technological resources and caters to 30% of the

population. It is structured according to the North American model organized

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around independent free-standing hospitals, individual medical offices and private

clinics, dependent on fee-for-service payments.

Countries with better Primary Health Care systems reports better

population health outcomes, reduced inequities in population health, and lower

rates of hospitalization resulting in reduced health care costs. In order to build a

strong primary health care system, conclusions from the literature identify that it is

important to focus on all attributes (access, comprehensiveness, continuity,

coordination, community oriented) of primary health care through the

implementation of multi-faceted interventions.

CHAPTER 3

RESEARCH METHODOLOGY
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This chapter explained the methods used in this study. These include

the researcher design, research locale, respodents of the study, sampling

techniques, population and sample of the study, research instrument and

valdation of research instrument, data gathering procedure and statistical

treatment data.

Reasearch Design

This study used the descriptive method of the survey type of research

which describes and interprets data and characteristics about the population

or phenomenon being studied. It entailed the collection of data, the

hypothesis or how to answer questions concerning the status of the study

(Khan, 2015).

The researchers made use of the descriptive method of research

where the basic intrument was a set of questionnaire made by the researcher

and personal data from of the respodents to secure the needed information.

Descriptive method of researcher was simply defined as involving

collection of data in order to test the hypothesis and to answer questions

concerning the current status of the subject study (Calmori-Calmori,2014).

Descriptive studies are valuable in providing facts on which scientific

judgment maybe used. This study utilized the descriptive method includes.

Descriptive method of research was a fact finding study with the adequate

accurate interpretation of the findings (Khan, 2015).

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Research Locale

This study was conducted in the selected barangay in the City of

Cabuyao, Laguna, namely Barangay Poblacion 1, Barangay Baclaran,

Barangay Butong, Barangay Casile, and Barangay Niugan.

Cabuyao (Filipino: Kabuyaw), or officially known as the City of

Cabuyao (Filipino: Lungsod ng Kabuyaw) was a first class urbanized city in

the province of Laguna, Phiippine. It was located about 43 Kilometers

southeast of Metro Manila and situated at the western portion of Laguna. It

was bound on the west by Cavite, on the north by the Sta. Rosa and on the

south by Calamba. Cabuyao City was approximately 54 kilometers away from

Sta. Cruz, the provincial capital, and 9 kilometers from the city proper of

Calamba City, the regional center of CALABARZON region.

Cabuyao City was formely the “Richest municipality of the philippines”

and the fastest growing municipality in Laguna, as evidenced with a large

populace of migrants working in the city`s industrial estates.

The City of Cabuyao has 18 Barangays: three (3) are poblacion

Barangays, six (6) are located along the national highway, six (6) along

Laguna de Bay and the remaining three (3) are located on the western side,

near the Cabuyao-Cavite boundary.

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The poblacion composed of barangays namely barangay uno,

barangay dos and barangay tres which classified as highly commercials area

and the center of business of the city of cabuyao situated in a flat terain.

The coastal barangays of the city of cabuyao nearly situated at laguna

de bay are Bigaa, Butong, Marinig, Gulod, Baclaran, with fast growing

population because of fast no of subdivision was being built and classified as

agricultural area.

The Barangays situated along the national highway are barangay

sala, Niugan, Banay banay, Pulo, San Isdro,Banlic, Mamatid, classified as

highly commercial and industrial area.

The Barangay along the idustrial zone are pittland and diezmo located

along the light industry science park. Which having an heteregenous

population.

The outmost barangay situated along the upper terain is barangay

casile classified as highly agricultural area. With less poupaltion.

The city covers an area of 4,291.5648 which was broadly classified

into agricultural, commercial, Industrial and built up areas.

The city consists mostly of rolling narrow plains and the remaining

areas, which are situated in the western side, has few elevated portion.

By virtue of Republic Act No. 10163, Cabuyao has been converted into

a Component City after the majority of votes casted by the residents dated

August 4, 2012 (http://www.cityofcabuyao.gov.ph/profile.php).

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Respondents of the Study

This study is about strenghtening Health care services in the city of

cabuyao. The main respondents of this study were the residents who avail

health care services of each barangay In addition, the barangay health

center personnel, such as the doctor on duty, nurses, staff and other support

staff who rendering service in the center. They differ in profile – respondent

such as (a) age, (b) gender, (c) monthly income, (d) highest educational

attainment, (e) frequency of visit and (f) lenght of residency. the respondents

were from Barangay Baclaran, Butong, Casile, Niuganand Poblacion uno.The

reserchesr want to find out from the respondent to assessed utilization of

health resources in terms of facilities to find out from the respondent

regarding the cleanliness of the health center, water supply, acesssibility

,spaces to cater older person. And also the acessibility in terms of health care

services in terms of free consultation, immunization,records, free seminars for

all respondent. The researchers want also to sought the answer from the

respondent, in terms of equipment.The respondent was ask if the health

center in their place was complete in termas and equiptment. The

respondent was also ask the availability of the personnel in the health center

were they are located. The respondent was also ask the acessibility to health

care access by means of transportation what are the means of transportation

like padyak, barangay patrol,.the respondt was also assess on the barriers of
 Pamantasan ng Cabuyao
COLLEGE OF NURSING
health resource in selected barangay when the are group according to

demographic profile in different variables like gender,age, monthly income,

educational attainmaint frequency of visit, years of residency. In conclusion

the respondent are those who avail services in term of health of selected

barangay of the city of cabuyao in relation health care accessiblity.

Sampling Techniques

The sampling technique used was the stratified random sampling. In

this sampling technique, the respondents of the study were randomly selected

from each barangay. In the sampling technique, selected senior citizens were

equal chance to be part of the study. In this technique, valid and reliable data

were collected, the researchershad drawn a good inferential and action

planthat addressedthe problem of this study.

In orderto determine the exact sample size of the study, the

researchers used Slovin`s Formula. The formula used is:

N
n=
1+ Ne2

Where:

N = Popuation

n = sample

e = margin of error (at 0.05 or 95% confidence interval)

251
n=
1+(251) ¿ ¿
 Pamantasan ng Cabuyao
COLLEGE OF NURSING
n = 155

Population and Sample

In this study, the researchers initially visited the selected barangay

health center in the city of Cabuyao to determine the average number of

respondent in their barangays.